Low Back Pain

Epidemiology

50-60% Life time incidence of LBP

15-30% prevalence among adults

1% of population are disabled because of LBP

15% of the sick leave

85% no specific diagnosis can be made

Highest prevalence 40-60 year of age

Overall incidence of LBP 45/1000 person per year

Clinical presentation

LBP +/- radiculopathy

Pain exacerbated with physical stress and
relieved with bed rest

P/E differentiate mechanical (non-specific) LBP
from serious spinal conditions (radiculopathy or cauda equina syndrome caused by PID, tumors,
infections…..)

History / red flags

Hx of cancer (prostate, breast, kidney,thyroid,
lung)

Unexplained wt loss

Immunosuppression

Pain that worse at rest psuedoclaudication

Pain not responding to conservative Rx
Skin or other systemic infection

Urine and fecal incontinence

Disc Herniation
L4-5, L5-S1 most common

Cervical and thoracic do occur

Thoracic: abrupt neuro deficits
Postero-lateral aspect of the disc

Not necessary to have history of strain or injury Unilateral radicular back pain with nerve root
impingement

X-ray only good if inter-vertebral disc is narrow


MRI is gold standard


Electromyelography localizes the specific nerve
root

Absolute indication for surgery

Significant muscle weakness

Progressive neurological deficit with bed rest

Bowel or bladder dysfunction

Relative indication for surgery

Pain despite bed rest

Recurrent episodes of severe pain
Discectomy/

Complications

Infection (superficial vs deep)

Increased deficit (injury to neural structure)

Dural tear (CSF leak)


Complications of positioning

Failed surgery (incorrect dx, incomplete surgery) Vascular injury